Changing the left ventricular shape in dilated cardiomyopathy: the Myosplint-procedure
Jan Groetzner, Helmut Mair, Lars Burdorf, Soren Schenk and Bruno Reichart
Department of Cardiac Surgery, Ludwig Maximilians University Hospital Grosshadern, Marchioninistr.15; D-81377 Munich, Germany
A 63-year-old female was admitted due to decompensated congestive heart failure. Echocardiography revealed reduced left ventricular (LV) ejection fraction (23%) and moderate mitral valve regurgitation. Myocardial biopsy confirmed the diagnosis of dilated cardiomyopathy. After adjustment of heart failure medication (diuretics, betablockers, ACE-inhibitors) the patient stabilized, and her NYHA functional class improved from IV to III within 10 days after admission.
Due to her history of multiple decompensations in the past despite optimized heart failure medication, the patient was considered for heart transplantation, however declined this option due to personal issues.
Therefore, a surgical alternative to transplantation was sought that would prevent ongoing LV dilatation and potentially lead to reverse remodeling. Accordingly, the patient was elected for a procedure aimed at change of the LV-shape and reduction of LV wall stress - the Myosplint® -procedure: Transventricular tension members (Myosplint©, Myocor Inc.) were inserted into the LV to draw the opposing walls together, reducing the effective radius. According to the law of Laplace, a reduction of radius correlates linearly with wall stress. Concomitantly, mitral valve regurgitation was corrected by ring annuloplasty. Surgery and postoperative course was uneventful, and the patient was discharged with significantly improved clinical status (NYHA I-II). The patient did not have any further episode of LV decompensation nor did she experience thromboembolic events. However, 20 months later, the patient suffered from intractable right ventricular failure (RV) due to RV dilatation. The patient then agreed to proceed with cardiac transplantation, which, after allocating a suitable donor graft, was performed successfully.
Figure legend
Left panel. Intraoperative, transesophageal echocardiography after transventricular insertion of 3 Myosplints (+). MV: Mitral valve. Right Panel. Transected LV of the explanted heart. There was neither thrombus formation nor ischemic myocardial regions near 2 of the 3 endotheliazed goretex Myosplints (+); (x): Mitral valve with annuloplasty.
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